Individual
DR. JILLIAN RENEE BARANOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4440 PORTAGE RD, SOUTH BEND, IN 46628-9570
(574) 234-8161
Mailing address
211 N EDDY ST, SOUTH BEND, IN 46617-2808
(574) 234-8161
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01096027A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300063787
—
IN
Enumeration date
05/11/2022
Last updated
08/05/2025
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